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Cornwall Partnership Trust (CPT) is the NHS organisation responsible for providing the majority of adult (18 and over) with mental health services in the county of Cornwall. Cornwall has a population of approximately 550,000 people. In Cornwall the ratio of acute psychiatric beds to population size is amongst the lowest in the country.
The majority of care takes place in the community but when a patient has a more serious issue they will receive care from Home Treatment Teams (HTT’s). If the patient requires further care they can be admitted to a mental health treatment centre as an inpatient.
CPT aimed to improve the effectiveness of this care pathway. Wanting to ensure their current inpatient capacity can match demand and avoid sending patients out of the county when no beds are available. It is the interface between the HTT’s and in-patient care, at both admission and discharge, which were highlighted as the main areas of focus for this project.
Map the Cornwall mental health services pathway focusing on the interfaces between HTT’s, inpatient admission/discharge and the inpatient care process.
Model the current functioning of the care pathway and identify any bottlenecks in the system.
Determine the inpatient bed capacity required to deal with current demand under current system conditions.
Determine the length of stay and discharge delay that would allow effective system functioning with current bed numbers.
Model a range of scenarios to investigate the impact on the functioning of the system of reduced avoidable admissions, reduced delayed discharges and other what-if questions identified during the process mapping phase of the project.
Investigate the impact of unnecessary referrals on current system functioning.
The most important finding to come out of this project has been that to ensure low waiting times and no patients being sent out of county changes are required to multiple part of the system. Changing only one aspect of the system can achieve these aims but the change would have to be so dramatic as to make it impractical.
Inpatient bed capacity, the rate of inpatient referral and inpatient length of stay are the three main drivers of the inpatient care system. By changing these three aspects of the system in combination the goals of low waiting times and no patients being sent out of county can be met.
Based on the three scenarios run where all three of these parameters are changed in combination changing the real world system by the following proportions will likely have the desired effect.
The greater the change that can be achieved to any one of these aspects of the system the less change required to the other parameters. The findings above provide a guide to the inner dynamics of the acute care pathway particularly highlighting the non-linear dynamic in the system which means that the outcomes of this system cannot be predicted using simple averages and straight line graphs. Improved data collection and analysis will help aid the understanding of the inpatient adult acute care pathway as it is adapted and changed.
For more information, read the final report.
Phil Confue (Chief Executive)
Richard Laugharne (Consultant psychiatrist)
Cornwall Partnership NHS Foundation Trust